Advances In Multidisciplinary Synthetic Therapy For Unresectable Liver Metastasis Of Colorectal Cancer (Three Cases Discussion)

Multidisciplinary synthetic therapy is a treatment based on physical and mental status, tumor location, pathological type, infringed range (disease stage) and development tendency combining with the change in molecular biology, to maximize the elimination or control of the tumor, prolong the survival time and to improve the patient's quality of life. For unresectable liver metastasis of colorectal cancer, multidisciplinary synthetic therapy mainly depends on systemic chemotherapy, molecular targeted therapy and minimally invasive interventional treatment.In terms of systemic chemotherapy, previous first-line drug has always been 5-fluorouracil. Capecitabine, oxaliplatin and irinotecan appeared in recently 10 years have become available first-line drugs with their own advantages. Oral chemotherapy drug capecitabine is a prodrug of 5-fluorouracil, with efficacy closing to intravenous infusion of fluorouracil + leucovorin, but less side effects. Oxaliplatin is a third generation platinum anticancer drug after cisplatin and carboplatin, with its character of no renal toxicity, and synergistic effect with fluorouracil. Irinotecan is a semisynthetic water soluble camptothecin derivative with broad spectrum of anti-cancer. The plan of irinotecan combining with fluorouracil is also the first-line therapy to oxaliplatin-resistant patients.Molecular targeted therapy is a new treatment by using specific inhibitors of molecular targets after choosing some tumor-specific molecules as target. Nowadays, the epidermal growth factor receptor inhibitor cetuximab and the vascular endothelial growth factor receptor inhibitor bevacizumab are mainly used in clinical. The former regards K-ras gene as its curative effect predictor, and it can be used alone or combined with chemotherapy. But the latter is invalid when used alone. Bevacizumab combined with chemotherapy can extend the whole survival period of patients.Minimally invasive therapy is a method to treat the local lesion from natural body cavity, skin physiology or vascular under the guide of image with on injury or little injury. It has the advantages of confirm effect, little injury, fast recovery and repeatedly using. In minimally invasive therapy, transcatheter arterial chemoembolization, radiofrequency ablation, cryoablation therapy of argon-helium knife and percutaneous ethanol injection are the most commonly used.In sum, different patients or at different stages of the same patient, different comprehensive treatment strategies can be used. In them multidisciplinary treatments above can also be alone or combined. For example, to patients who can not tolerate high intensity chemotherapy, the strategy of single-agent chemotherapy±molecular targeted therapy can be used; to patients who can tolerate high intensity chemotherapy, the strategy of combined chemotherapy±molecular targeted therapy can be used; to patients who can tolerate high intensity chemotherapy with the distribution of diffuse liver metastases or richer blood supply, the strategy of transcatheter arterial chemoembolization±molecular targeted therapy can be used; and to patients who can tolerate high intensity chemotherapy with the distribution of non-diffuse liver metastases, the strategy of minimally invasive interventional treatment±chemotherapy±molecular targeted therapy can be uesd usually.